Provider Demographics
NPI:1629541644
Name:CAIN, MICHAEL P (MA, LADC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:CAIN
Suffix:
Gender:M
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 UNIVERSITY AVE W STE N385
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2872
Mailing Address - Country:US
Mailing Address - Phone:612-454-2474
Mailing Address - Fax:
Practice Address - Street 1:1821 UNIVERSITY AVE WEST, SUITE N385
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:612-454-2474
Practice Address - Fax:651-647-9147
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302268101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN205557491Medicaid